When Should You Get Botox (If Ever)?

I’ve tried to start this story many times, but each time my fingers falter on the keyboard. I’m reminded of bungee jumping in New Zealand five years ago; standing on the edge of a cliff, mind completely ready to take the leap, knees locked together, frozen in fear, reluctant to cooperate. I don’t think it’s because I’m sheepish (the Internet is acutely aware of what goes on behind my unlocked doors, as it is the minute details of my shedding uterus), and it’s not the same breed of laziness that prevented me, for months, from writing a story on the conveniences of going to bed at what most would consider a very regular hour. I think the reason I’ve been hesitant to put fingers to keyboard is because, while it’s not a taboo anymore, I’m still not sure how I feel about Botox. While I’m critical of a society that necessitates it, I guess my general stance is: You do you, gurl.

I’m a fence-sitter who’s fallen into Camp Botox, unsure of whether to claw her way back up to the comfy timber ledge or commit to a lifetime of costly, thrice-yearly injections in exchange for a crinkle-free forehead.

In my quest to further navigate how I feel about the big B, I first enlisted the help of Dr. Joseph Hkeik of All Saints Skin Clinic in Sydney’s Double Bay, before looking to three clever, considered women for guidance—Byrdie Australia’s angelic Lisa Paultny, our Founder and Editor in Chief here at THE FILE, Carlie Fowler, and my best friend, Hannah, who moonlights as Production Supervisor over at Animal Logic (they make Lego movies, you heard of them?). I’ll delve into their feelings about Botox in a minute, but first, a bit more about me:

I’ve been debilitatingly self-conscious of my frown line since it reared its ugly, creviced head when I was 23. 23! Imagine. For me, it’s the centre piece of every photo I’m in, garishly commandeering attention away from the other corners of my face. I weep when I catch my reflection in shop windows, and practically drown in tears when I go to take a photo and the camera is facing inward, exposing my forehead for what it truly is: A mud-cracked desert.

Countless co-workers have told me that my resting face is a marriage of confusion, concentration, and deep rage. When I wake up, I’m frowning, as am I when my head touches the pillow at night. My old housemate and I developed a special bond over our shared forehead creases—we could (and did) talk about them for hours. Like any insecurity or fear we collectively harboured, we assuaged our forehead crease phobia with a combination of hyperbole and humour. “Mine is terminal,” I’d laugh. “It’s going to split our foreheads in half,” she’d jest.

After a particularly horrific selfie threatened to send me into a deep, self-loathing spiral from which I may have never returned, I decided to have an expert temporarily paralyze the muscles that permanently furrowed my brows. Enter Dr. Hkeik.

The first port of call, once I was in the chair facing one of the best surgeons in the country, was to hurl a thousand questions at him. Obvy. I kicked off the torrent of Qs with one on the changing conversations around Botox. “The ice has broken,” he said. “In the past, there were mothers who would sneak in and sneak out, without letting anyone know. Now it’s more of a conversation of where you go and how much you get done. The actual fact that you do get Botox is no longer a taboo or a stigma, and I guess, because there’s this degree of prevention that everyone talks about, people believe they should start early.”

Is there merit in preventative Botox? “It’s only preventative in certain areas in small doses, not in the way you treat everyone,” he says. “The trouble with young people is that they are getting too much work done, in my eyes. They probably don’t want to hear me say that. [Laughs] They’re like, ‘More is more,’ but I definitely think less is more for the younger generation, really. I only treat them if they have a really obvious frown line, if they’re going into their twenties or mid-twenties. Yes, it’s good to treat that. But to go to town and treat every muscle on your face just because it’s available? I don’t think there’s a benefit.”

And has he turned anyone away? “I’m not really for people getting a lot of Botox at a young age. I think it’s been taken to an extreme, and I think it’s because a lot of the chain clinics are targeting all the young people. They get them in the door because they want to do something like microdermabrasion or laser hair removal, and while they’re there, they sell them Botox. It’s just the way it’s being sold to them. They have their reasons for doing it this way, but I don’t agree with it. When you’re young, you should look after your skin, protect your skin, nourish your skin, and prevent ageing that way. All Botox does is erase wrinkles; it doesn’t teach you how to fix your skin problems, or the importance of wearing sunblock—it just teaches you to focus on wrinkles and lines. With preventative Botox, it’s all about the dose. You don’t treat to make sure everything is frozen. That’s not the end point.”

I was terrified of looking “done,” and as someone with an incredibly expressive face, didn’t want to lose the ability to move a quarter of my face, either. Dr. Hkeik dimmed these fears swiftly: “No one is born with a frozen muscle. People ask for the frozen look because they’ve had it before, so they use that as their guide. There’s no need to actually freeze the muscle—all you want to do is relax the muscle. You don’t want to get rid of the character. When you get Botox for the first time, you’ll get the frozen look for a couple of weeks, but that will settle. When it does, you want that muscle to be less active—you want to train your brain to not use it all the time.”

Because I’m greedy, when I was presented with the first-time visitor questionnaire, I ticked that my areas of concerns were my smile, frown, and forehead lines. In reality, my frown line is the only thing that’s ever bothered me. Dr. Hkeik had me raise my eyebrows, frown, and then smile, and deduced that a few of my forehead lines (along with my frownie) were visible when I rested. He recommended having a modest amount of Botox injected into both my frown and forehead areas—my tiny smiles lines could stay. We both agreed I should keep some movement in my face, and then spent 10 minutes Google searching over-the-top, tragic celebrity Botox jobs, mainly to highlight what happens when you go overboard, but also because who doesn’t love a good before and after series?

The main thing I took from Dr. Hkeik was that great Botox is all in the application. He’s dedicated to an integrative approach when it comes to beautiful skin, combining minimal Botox and filler with treatments, sunscreen, and products that are tailored specifically to your skin concerns. He’s very much about the “less is more” approach, and is akin to an artist when it comes to his craft. “Injecting filler is like sculpting,” he tells me. “If you can’t sculpt, you shouldn’t be doing filler.”

I’m lucky enough to be in a position where I can visit one of the best surgeons in the country (world), but I wondered about those who aren’t in a financial position to do so. For people who aren’t flushed with cash, he recommends doing your homework and going to a professional who’s been at the same place for a long time, doing it on a regular basis, as opposed to heading into just any beauty salon, where the doctors are more likely to be more transient (and therefore less accountable).

I’m as neurotic as I am greedy, so my last question pertained to the long-term effects of Botox—something that !terrifies! me. Again, he assured me that if the Botox is injected correctly, and is a therapeutic dose, there shouldn’t be any negative effects in the long-term. If you’re doing too much, you can make the muscle atrophy. “As is the case with any muscle, if you don’t use it, it will shrink. Facial muscles are the same. If you don’t use them, they will shrink, and if they shrink, you will have to use filler. You risk looking older with no wrinkles, if that makes sense. Some women have very thin skin, and it can make them look skeletal—you don’t want that. You want some padding on the face. What makes us look younger is the padding. If you were going to go on the journey [of frequent injections], don’t get too much. Keep the dose realistic. Don’t aim for the frozen look.”

With this verbal primer and a little bit of ice to my lines, I went under the needle. I had no bruising whatsoever. At Dr. Hkeik’s recommendation, I went home, read a book, and abstained from exercise. Since having it done a month ago, I’ve been treating the tiny, smooth gap between my eyebrows like a newborn puppy or recently-acquired house plant. I monitor its progress daily, making mental notes on the ease at which I can move my face. While I’m enjoying the benefits of not looking like an angry old man yelling at a cloud, I’m not enjoying this obsessive new hobby much, either. What I do love, though, is not wasting energy worrying about two little lines on my face.

After swanning out of All Saints, my initial plan was to not tell anyone I’d had it done—a naive undertaking for a compulsive over-sharer. Whenever someone compliments me on my skin these days (which is a lot more since getting Botox, might I add), I’m all “THANKS! I just got BOTOX!” The reception of this has been varied, too: Those without ovaries or the societal pressure to look 12-years-old forever have been the swiftest to judge, while most of my girlfriends (even those opposed to the idea) have been slapping nothing but veritable high fives my way. I mediate the reasons I got it accordingly. “I get bad tension headaches,” I tell the naysayers. To the fence-sitters, everything is content. To the fans, I pass along Dr. Hkeik’s number, and implore they saunter through the lush, black doors of All Saints Skin Clinic themselves before allowing him to run his magical needle across whatever lines have immobilised their confidence.

That’s just my story, though. Remember those three women?

Lisa, 32

“I’m not sure I had an ‘aha’ moment per se, but I do recall noticing the frown line between my brows getting deeper during my mid-twenties. That particular line is genetic (mum has it, sister has it), and nothing topical helped to soften it. I don’t remember exactly how old I was when I had my first go at Botox, but I’d say I was roughly 24. Young, yes. I only wanted that one line treated and refused to have anything else done. I still don’t do my whole face—I don’t care about looking “young,” I just really hate that goddamn line. I feel like it makes me look constantly peeved or angry.

I go to Dr. Jeremy Cumpston at Ageless Clinics. He’s an incredibly intelligent and honest human, and I know he would never push treatments on me, or make me look ‘done’ when that’s not what I want. Botox takes a few days to kick in, so it’s not like you see immediate results. When I did eventually see an improvement, I was impressed. The line was gone! So yes—I have continued to get it done, but not with any kind of frequency. I’ve always been minimal about it, to the point where I don’t have regular appointments to top it up. Once I see that line staring back at me again, I call Jeremy. I can’t say for sure if it’s going to be a lifetime thing, and I do wonder if, at some point, I’ll decide one forehead line is no big deal—possibly when there are a hundred others to consider? Time will tell.

As I’ve grown older, I’ve thought more about the potential impact on my endocrine system. I have PCOS (polycystic ovary syndrome), and inflammation is a thing I have to think about on a daily basis. I’ve asked myself why I care so much about limiting sugar, dairy, and wheat, when I’m also willingly inject toxins into my face. It’s not always an easy thing to reconcile. I’ve read enough to convince me that Botox is safe when used correctly, though I do realise that placing any sort of toxic load on your body can take a toll. I have sensitive hormones, so I know I need to be careful. It’s not something I’ve fully reconciled in my mind, to be honest.

As far as misconceptions go, I think a lot of people—particularly men—believe Botox always results in a specific look. I’ve found a lot of the judgement stems from a place of, ‘Why would you want to look like that?’ because they think you’re going to come away from a treatment looking like a Real Housewife. Obviously, in the hands of a skilled practitioner, that isn’t the case. I’ve never personally felt judgement around Botox use, but considering what I do for a crust, that’s to be expected.

I have a lot of feelings about how women are made to feel about their faces and bodies, but they’re far too complex to detail here. I will say this, though: I hate the idea that anyone would change their appearance because they feel that they should. Wanting a few less lines (or a different hair colour, or a different nose) isn’t the same as feeling that you have to because you won’t be good enough until you do.

I didn’t get Botox because I thought, ‘Shit, I need to halt the ageing process.’ I got it because I hated that I looked pissed off all the time. That said, I have no issue with that reasoning. It’s your face—I wouldn’t tell you what you should and shouldn’t do with it.

I think a major issue we face as a society is that we raise girls to believe their beauty is their complete worth. It’s so insidious. Think about how people tell a little girl ‘You’re so pretty,’ but a little boy gets ‘Look how clever you are!’ That’s problematic for obvious reasons—as girls and women, we are so many things. I know it seems the beauty industry plays on that by creating ‘problems’ we need to ‘fix,’ but it’s a chicken or egg situation. If Mecca shut down tomorrow and the world’s stores of Botox dried up, do you think women would stop searching for wrinkle cures? I don’t. It’s complex.

I would absolutely not have Botox done while pregnant. No way, Jose. There have been no studies around if or how Botox affects a developing foetus, or even whether it can cross the placenta. I wouldn’t consider it. I don’t think a responsible practitioner would administer injectables to a pregnant woman, either.”

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Carlie, 34

“My personal view? It’s terrifying. I feel the true danger lies not in the injection itself, but in women feeling that, once they get Botox, they’ll feel better about who they are as a human being – and that’s something we all need to question deeply, within ourselves.

Why are we all so afraid to feel our age? Why is everyone trying to be something more – more beautiful, more youthful – when the truth is, we’re all already enough. We were enough the day we were born, but somewhere along the line, something got a hold – presumably society’s tentacles – and told us we needed to be more. More beautiful. More interesting. More intelligent. Funnier. That we need to look a certain way, feel a certain way, and I call bullshit. I call bullshit on the whole thing. None of that is the answer. Botox included.

Why are we all so eager to fix the ‘flaws’ that society deems flaws, that actually make us unique, interesting, and beautiful in the first place? If men didn’t exist, if this need for identification, approval, or Instagram didn’t exist, would women still be signing up to injectables at the rate they are? I’m not entirely sure. Why aren’t men signing up at the same rate women are? Because society says they don’t have to look younger, that’s why. As women, I feel like we’re all buying into something that’s society-driven. It’s man-made. It’s an illusion.

We’re living longer, but we’ve never been more stressed, anxious, sick. ‘Answers’ like Botox are not making things better, they’re making things worse. The way we’re living, the things we are normalising, is really off. A 21-year-old signing up for Botox is not normal.

There are women who wear their ages on their faces, like they’ve lived, y’know? And they’re awesome because of it. Lauren Hutton is one of those women. I think about someone like Lauren injecting her face, and it would be a tragedy for women everywhere, for humanity, to miss that level of graceful ageing, to miss her true expression, which is part of who she is, and part of who we all are. The confidence she emanates from owning her age is something that requires a great deal of self love and appreciation, and that to me is one of the true markers of beauty.

I wish we could all own it a little more, you know? Not give in to the pressure. Band together as women, accept each other for who we truly are. Claim it in ourselves first, and feel the flow-on effect from that.

I think we need to get to the heart of what is driving us, as a collective, to feel the pressure, the anxiety, when it comes to ageing, and to start to shift that feeling within ourselves to a different place that feels more real, more whole, more loving. And I believe that begins with a deep level of honesty and responsibility.

It’s important for me to also point out that I say all of this with the deepest amount of love and respect for women everywhere. It’s why I started this site. It’s why I believe that, one day, THE FILE could make a difference, in talking about things like this, presenting different points of view, and in profiling women that keep it as real as we do. And, hopefully, there is a 21-year-old out there who reads these words and might feel the same way. Maybe it sparks something in her that makes her feel differently, allowing her to connect more deeply with herself. If we can achieve that, I’m a happy woman.”

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Hannah, 26

“Overall I’m mostly wary of it, so I wouldn’t say I’m 100% for or against, but I definitely lean hard towards the latter. I don’t want to have it done, and I think it’s mainly because my mum brought me up in a very naturally-minded way when it came to skin care and health care. I saw a naturopath for most of my teen years, because my mum swore off doctors for a while, etcetera. It seems like I’d be cheating some of my core beliefs if I suddenly went and got chemicals squirted into my forehead (which is precisely where I would have it done, if I were to ever get it, by the way).

My views on botox have most definitely shifted over time. I’m more open to it and that’s mostly due to my friends and family having it done, and being very chill about it. But, I definitely do have concerns about the long-term effects of botox. My boyfriend works in the medical industry and he deliberately feeds me horror stories about it. One in particular is about muscle dystrophy, . While I’m definitely not about it now, I can see my vanity taking over and my views on botox shifting in maybe 15 years’ time, when all my friends look fabulous and I look like a sultana. [One of the biggest misconceptions about botox] at the moment, I think, is that it makes you more beautiful. It doesn’t!

My friends and family have had botox done, and at the end of the day, I’m supportive, because ultimately it’s their decision. I like to focus more on prevention through the skincare products I use, which at the moment are: Mecca Save Face 50SPF+ and Dermalogica c-12 serum.”

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Words, Madeliene Woon.

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Botox is a huge topic—one that’s too cavernous and complex to properly address in one article (here’s looking at you ageism). While I could probably keep hashing out my thoughts on it until the turn of the year, we’ve all got places to be. If you have any questions you’d like answered, drop them in the comments below—we’ll do our best.